Effects and costs of implementing predictive risk stratification in primary care: a randomised stepped wedge trial
| Autor: | Victoria Williams, Deborah Fitzsimmons, Ceri Phillips, Bernadette Sewell, Alison Porter, Mark Kingston, Ian Russell, Daniel Warm, Jan Davies, Angela Farr, Hayley A Hutchings, Deborah Burge-Jones, Shirley Whitman, Helen Snooks, Leo Lewis, Alan Watkins, Jeremy Dale, Kerry Bailey-Jones, Helen Howson, Martin Heaven, Bridie Evans, Gareth John |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty emergency department Cost effectiveness cluster trials General Practice Primary care Risk Assessment State Medicine 03 medical and health sciences Quality and Outcomes Framework Young Adult primary care 0302 clinical medicine Surveys and Questionnaires Medicine Stepped wedge Humans 030212 general & internal medicine cost-effectiveness Original Research Wales Primary Health Care business.industry 030503 health policy & services Health Policy Health services research Attendance Emergency department Middle Aged health services research Hospitalization Emergency medicine Risk stratification Costs and Cost Analysis Female 0305 other medical science business Emergency Service Hospital |
| Zdroj: | BMJ Quality & Safety |
| Popis: | AimWe evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to focus care on those at highest risk of emergency admission to hospital. The aim of this study was to evaluate the costs and effects of introducing PRISM into primary care.MethodsRandomised stepped wedge trial with 32 general practices in one Welsh health board. The intervention comprised: PRISM software; practice-based training; clinical support through two ‘general practitioner (GP) champions’ and technical support. The primary outcome was emergency hospital admissions.ResultsAcross 230 099 participants, PRISM implementation increased use of health services: emergency hospital admission rates by 1 % when untransformed (while change in log-transformed rate ΔL=0.011, 95% CI 0.010 to 0.013); emergency department (ED) attendance rates by untransformed 3 % (while ΔL=0.030, 95% CI 0.028 to 0.032); outpatient visit rates by untransformed 5 % (while ΔL=0.055, 95% CI 0.051 to 0.058); the proportion of days with recorded GP activity by untransformed 1 % (while ΔL=0.011, 95% CI 0.007 to 0.014) and time in hospital by untransformed 3 % (while ΔL=0.029, 95% CI 0.026 to 0.031). Thus NHS costs per participant increased by £76 (95% CI £46 to £106).ConclusionsIntroduction of PRISM resulted in a statistically significant increase in emergency hospital admissions and use of other NHS services without evidence of benefits to patients or the NHS. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|